Provider Demographics
NPI:1851260558
Name:REDFERN, SAVANNAH GRACE
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:GRACE
Last Name:REDFERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 G ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3054
Mailing Address - Country:US
Mailing Address - Phone:707-400-5606
Mailing Address - Fax:
Practice Address - Street 1:974 RALSTON AVE STE 8
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2249
Practice Address - Country:US
Practice Address - Phone:700-400-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT156964106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist